Surgical trends
domestic development of telemedicine. During the pandemic, there were multiple benefits that facilitated pre-operative consultations, postoperative follow-ups and remote patient monitoring. This approach, which has continued in some
areas, has benefitted patients by not having to travel to hospitals for consultations thus reducing the opportunities for infections and saving patients time and money. Wearable devices will become more
widespread in future, which will enable real-time tracking of patient health metrics, including vital signs, physical activity and wound healing. This valuable data can inform clinical decision making, enhance patient engagement and enable timely interventions where complications are developing. There are a number of potential uses for training and the use of virtual reality for simulation exercises.
Training and patient safety The risks faced by patients from innovative new techniques can be substantial. The history of innovation into healthcare is sadly littered with experiments, which did not go well, and patients were harmed. Surgical innovation has often been driven by one surgeon’s enthusiasm. In this day and age, it is safe to say that there
is a great deal of advice and guidance to reduce risks to patients, to train junior surgeons and to mitigate the risks from a new device or technique. Most surgery now takes place in teams and effective teamworking results in better outcomes for patient safety. Even so, there remain issues about:5 l The processes by which a surgeon (and the
Patients increasingly need to have full disclosure of the innovations, and the surgeon who will perform the surgery needs to ensure that informed consent is obtained with transparency.
rest of the surgical team) train in a new approach
l The oversight and quality assurance underpinning the training
l How patients are selected l How consent is obtained l How the outcomes of the new approach are audited
The issues are key to the development of the next generation of surgeons, so not only do they have an opportunity (many times over) to become familiar with the technology, but also to practise the techniques. A key focus will be on maintaining the importance of conventional surgical skills amidst the rise of accessibility to new technologies. Integrating these new technologies into surgical training has never been more important. There is no doubt that the current method
of training future surgeons needs to be transformed, so that there is space for learning and integrating the new technologies into conventional training programmes. With the rate of change occurring, leadership needs to be part of the development. Hospital leaders, as well as senior surgeons, need to be cognisant of the pace of change and to enable those learning to practise the new techniques.
Conclusion Without a doubt, the pace of change is extraordinary and perioperative teams of all shapes need to be aware of the developments and ensure they keep up. Thirty years ago, many of the laparoscopic changes were a little haphazard, with maybe one key surgical innovator driving the changes together with medical device companies leaping onto the bandwagon. There was no effective governance or
oversight from peers to ensure that the surgery being undertaken was appropriate for the patient and had good outcomes. Therefore, the guidance from the Royal College is to be welcomed. It needs to be understood and implemented with all the correct frameworks in place. We all know that the interests of patients
are paramount – new techniques need to be added to the hospital risk register. We can only hope that all the frameworks and guidance do not subsume innovation, as it is very often the pioneers who push the boat out a little further who make the difference.
CSJ
References 1. Royal College of Surgeons 2019 Surgical Innovation, new techniques and technologies. Accessed at
https://www.rcseng.ac.uk/-/ media/Files/RCS/Standards-and-research/ Standards-and-policy/Good-Practice-Guides/ Old-documents/Surgical-Innovation-New- Techniques-and-Technologies.pdf
2. Skivington K, Matthews L, Simpson SA, et al A new framework for design and evaluating complex interventions: update of Medical Research Council guidance. BMJ 2021;374:n2061 Accessed at
https://www.bmj.com/ content/374/bmj.n2061
3. Dagnino G, Kundrat D 2024 Robot assistive minimally invasive surgery: trends and future directions. Accessed at https://link.springer. com/article/10.1007/s41315-024-00341-2
4. Picozzi P, Umberto N, Chiara L et al 2024 Advances in Robotic surgery: A review of new surgical platforms Accessed at https://tinyurl. com/bdbcc8wd
5. Bobade S, Asutkar S 2024 Current trends and future directions in surgery : A brief scoping review. Accessed at
https://malque.pub/ojs/ index.php/mr/article/view/5345
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